Individual
KRISTEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
5959 CORSON AVE S, SEATTLE, WA 98108-2605
(206) 971-7466
(206) 971-7515
Mailing address
1200 CORPORATE DR STE 400, BIRMINGHAM, AL 35242-5424
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01326
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0665463
—
IA
Enumeration date
03/01/2007
Last updated
04/06/2018
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